EMS World

NOV 2018

EMS World Magazine is the most authoritative source in the world for clinical and educational material designed to improve the delivery of prehospital emergency medical care.

Issue link: https://emsworld.epubxp.com/i/1042097

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Page 30 of 51

30 NOVEMBER 2018 | EMSWORLD.com ISSUE FOCUS: PATIENT AND PROVIDER SAFETY first phrase uttered during our training and testing stations. Even af ter that initial contact, smar t students and seasoned providers know they need to keep their eyes open for changes that may become dangerous. If the environment becomes too hazard- ous, the providers can quickly remove themselves and their patients to the rela- tive security of their ambulance, where at least they can exit the scene quickly. Extracting themselves from the environ- ment of ten immediately reduce s the threat and minimizes the risk to the team on what will likely be their only interac- tion with this patient in that setting. Scene s afet y considerations dif fer bet ween communit y paramedic s and traditional EMS providers from the point at which the patient enters the system. A call to 9-1-1 leaves traditional EMS per- sonnel no opportunity to decide whether the patient's current location is the saf- est place for them to meet. Community paramedics, on the other hand, will have repeated visits with the patient and thus more potential exposure to dangers in their environments, but also more oppor- tunitie s to plan and reduce any risk s involved in conducting those contacts. Since Melissa's interaction wa s one of the first times a CP in the Pittsburgh region encountered such a serious threat, the manager of the AHN program reached out to the other CP programs in the region to conduct a joint af ter-action review (AAR) in an ef for t to share the lessons learned from this experience and discuss best practices moving for ward. After-Action Meeting The combined teams worked through a "sustain and improve" list, a format com- mon in AAR processes in the U.S. mili- tary. Unlike a critique, this format is not focused on dissecting the event itself for failure points. Instead the goal is to use a chronological review by participants as a basis for identifying areas where current doctrine, training, SOPs, and workflows were effective and should be reinforced, and areas where current approaches did not or would not have worked. The following were determined to be practices that contributed to the safe exit of the CP from the hostile encounter. 1) Motivational interviewing—Melissa's skill in motivational inter viewing (MI) contributed to the rappor t that already existed and her understanding of the range of challenge s her p atient wa s experiencing. Her MI skill s al so likely p r eve n te d h i s r a ge f r o m e s c al ati n g toward her. The patient appeared to treat Melissa as a confidant and ally, possibly because at the time of crisis she already knew much of his back ground and had used MI technique s prior to this visit to express empathy and suppor t. Had she approached the conversation as an outsider or followed a traditional medi- cal or task-oriented line of questioning, it's likely his attitude toward her would have been different and potentially more dangerous. Similarly, her use of reflec- tions, affirmations, and summaries likely helped deescalate his frustration while she was present. Thanks to the rapport she developed and her use of MI skills during the crisis, he did not perceive her to be a part or cause of his problems. 2) Identif y and maintain an escap e route— D raw ing on her exp erience a s a traditional paramedic, Melis s a had identified an e scape route w hen she first encountered the patient. Thank s to her previous training, Melissa began

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